[Preprint] Nirmatrelvir and the Risk of Post-Acute Sequelae of COVID-19, 2022, Al-Aly et al

Abstract:

Long Covid -- the disease encompassing the post-acute sequelae of SARS-CoV-2 (PASC) -- affects millions of people around the world. Prevention of PASC is an urgent public health priority. In this work, we aimed to examine whether treatment with nirmatrelvir in the acute phase of COVID-19 is associated with reduced risk of post-acute sequelae.

We used the healthcare databases of the US Department of Veterans Affairs to identify users of the health system who had a SARS-CoV-2 positive test between March 01, 2022 and June 30, 2022, were not hospitalized on the day of the positive test, had at least 1 risk factor for progression to severe COVID-19 illness and survived the first 30 days after SARS-CoV-2 diagnosis. We identify those who were treated with oral nirmatrelvir within 5 days after the positive test (n=9217) and those who received no COVID-19 antiviral or antibody treatment during the acute phase of SARS-CoV-2 infection (control group, n= 47,123).

Inverse probability weighted survival models were used to estimate the effect of nirmatrelvir (versus control) on a prespecified panel of 12 post-acute COVID-19 outcomes and reported as hazard ratio (HR) and absolute risk reduction (ARR) in percentage at 90 days. Compared to the control group, treatment with nirmatrelvir was associated with reduced risk of PASC (HR 0.74 95% CI (0.69, 0.81), ARR 2.32 (1.73, 2.91)) including reduced risk of 10 of 12 post-acute sequelae in the cardiovascular system (dysrhythmia and ischemic heart disease), coagulation and hematologic disorders (deep vein thrombosis, and pulmonary embolism), fatigue, liver disease, acute kidney disease, muscle pain, neurocognitive impairment, and shortness of breath. Nirmatrelvir was also associated with reduced risk of post-acute death (HR 0.52 (0.35, 0.77), ARR 0.28 (0.14, 0.41)), and post-acute hospitalization (HR 0.70 (0.61, 0.80), ARR 1.09 (0.72, 1.46)). Nirmatrelvir was associated with reduced risk of PASC in people who were unvaccinated, vaccinated, and boosted, and in people with primary SARS-CoV-2 infection and reinfection.

In sum, our results show that in people with SARS-CoV-2 infection who had at least 1 risk factor for progression to severe COVID-19 illness, treatment with nirmatrelvir within 5 days of a positive SARS-CoV-2 test was associated with reduced risk of PASC regardless of vaccination status and history of prior infection. The totality of findings suggests that treatment with nirmatrelvir during the acute phase of COVID-19 reduces the risk of post-acute adverse health outcomes.

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I think we've seen from the previous Al-Aly Veteran's Affairs studies that their data fails to capture a lot of Long Covid of the ME-type (as opposed to things like acute cardiovascular outcomes), but it's still pretty interesting to see a significant reduction in risk across a variety of post-acute symptoms (including fatigue, but they are definitely only capturing a small portion of this) for those who took Paxlovid.

 

Pfizer’s Paxlovid Antiviral Lowered Long-Covid Risk in Study

• Drug cuts risk of fatigue and other lingering symptoms by 26%
• Study supports wider Paxlovid use to avoid disabling problems

Pfizer Inc.’s blockbuster Paxlovid antiviral that lowers rates of illness and death in people infected with the coronavirus also cuts the risk of some symptoms of disabling long Covid, a study found.

Taking the oral medication within five days of testing positive for a SARS-CoV-2 infection was linked to a 26% lower risk of lingering post-viral complications, researchers with the Veterans Affairs St. Louis Health Care System said in the study. That equates to 2.3 fewer cases of long Covid within three months of infection for every 100 patients treated, according to the findings released Saturday.

https://www.bloomberg.com/news/arti...g-covid-risk-in-study?leadSource=uverify wall

 

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